Epidemiological, Clinical, Therapeutic and Evolutive Profile of Primary Open-Angle Glaucoma in a Cameroonian Population

Background: Sub-Saharan Africa has the highest prevalence of primary open-angle glaucoma (POAG), at 4.2%. The efficacy of medical treatment has been demonstrated and remains one of the treatments of choice for POAG. However, in sub-Saharan Africa, its effectiveness has many challenges, due to multiple factors, including cost and access to care. Thus, the present study aimed to determine the epidemiological, clinical, therapeutic and evolutive profile of primary open-angle glaucoma patients. Methodology: A descriptive cross-sectional study was carried out in two hospitals in western Cameroon. Epidemiological, clinical, therapeutic, and evolutionary data on intraocular pressure at one year after medical treatment were analyzed. SPSS version 23 software was used for statistical analysis, with a significant p-value set at 5%. Results: A total of 201 patients with POAG were included in the study. The population comprised 100 men and 101 women, with a mean age of 54 ± 12 years. At diagnosis, the mean intraocular pressure was 23.9 ± 8.70 mmHg for the right eye and 25.5 ± 9.57 mmHg for the left eye. The mean cup/disc ratio was 0.64 ± 0.2 [0.2-1] and 0.67 ± 0.19 [02-1] in the right and left eyes, respectively. Monotherapy was the most prescribed treatment [59.2%]. After one year of treatment, intraocular pressure was reduced by 15.5% with beta-blockers, 23.66% with prostaglandins, 19.11% with carbonic anhydrase inhibitors, 35, 92% with beta-blockers and carbonic anhydrase inhibitors, 25.92% with beta-blockers and prostaglandins, 48.03% with carbonic anhydrase inhibitors and prostaglandin agonists, and 38.77% with triple therapy. Taking glaucoma severity into account, a significant reduction in intraocular pressure at one year was observed in all participants [p 0.05]. However, the target pressure was obtained in 47%, 20% and 14% of eyes suffering of mild, moderate, and severe grade of POAG respectively. Conclusion: In the present study, there was a significant reduction in intraocular pressure after one year of medical treatment. However, the reduction in intraocular pressure does not allow the target pressure to be reached in severe forms. Thus, alternatives to the medical treatment of POAG should be discussed early in the present context. .

Relation between Obstructive Sleep Apnea-Hypopnea Syndrome and Glaucoma in a Sub-Saharan African Population

Introduction: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a frequent pathology worldwide whose main mechanism is a complete or partial obstruction of the upper airway. One of the pathophysiological mechanisms described in primary open-angle glaucoma is that hypoxia in the optic nerve progressively destroys the retinal cells leading to the onset and/or aggravation of glaucoma. The aim of the study was to evaluate the risk of OSA in patients with primary open-angle glaucoma. Methodology: An analytical study was conducted from January to May 2020 at the UHC. After obtaining ethical clearance, 112 patients including 50 glaucoma patients (44.64%) and 62 in the control group were enrolled. Sociodemographic and clinical data were collected from the medical records of the participants, with or without glaucoma, and a questionnaire was administered and a clinical examination performed. The STOP BANG score was used to determine the risk level of OSAHS. Statistical analyses were performed using Epi Info version 7.2. Results: A female predominance was found (60%) in the glaucoma group with a mean age of 55 ± 17 years against 49 ± 18 years in the control group. The high risk of OSAHS was more associated with glaucoma patients. In glaucoma patients, an association was found between high risk of OSAHS and snoring (OR = [1.43 - 849.53];p = 0.029) as well as insomnia (OR = [1.36 - 482.86];p = 0.030). Conclusion: High risk of OSAHS was found in participants with chronic open-angle glaucoma. Signs of OSAHS should be sought in chronic open-angle glaucoma as it may be a factor in its progression.

Ocular Findings in HIV-Positive Children in Two Hospital Facilities in Yaoundé, Cameroon

Background: HIV infection in children as well as adults remain a disease with potential multisystemic disorders despite the increased use of Highly Active Antiretroviral Therapy (HAART). The aim of this work was to determine the profile of eye diseases among HIV-positive children aged 5 to 15 years in the Mother and Child Centre of the Chantal Biya Foundation and the University Hospital Centre (UHC) in Yaoundé. Materials and Methods: an analytical study was conducted from June 1, to July 31, 2019. Our sample consisted of all children aged 5 - 18 years who were HIV positive and whose parent or legal guardian gave his or her consent. A complete clinical examination was performed. The following variables were collected: socio-demographic data, Immunological data. A comprehensive eye exam was also performed. Data were analysed by the Epi info 3.5.4 software. Results: A total of 53 children were retained for the study. The population consisted of 28 boys (52.3%), for a sex ratio of 1.12. The mean age was 12.7 ± 4.2 years [5 - 18 years]. And 84.9% of children had normal immune status. The average duration of HAART was 8.3 ± 3.9 years [0 to 16 years] with more than half (50.9%) of the children on treatment for more than 8 years. The main eye complaints were pruritus (11.32%), eye pain (11.32%) and tingling (9.43%). The frequency of ophthalmological manifestations was 52.8% with adnexal involvement the most frequent (34%), followed by anterior (7.5%) and posterior segment involvement (1.9%). Anterior segment involvement was marked by granulomatous anterior uveitis, keratouveitis and corneal ulcer. A cytomegalovirus retinitis and a macular scar of a unilateral retinitis were found in 2 patients. In a multivariate analysis, elevated CD4 count (>500) was associated with ocular manifestations. Conclusion: In the HAART era, an ocular examination is mandatory to prevent harmful eye diseases among children because ophthalmological diseases remain frequent. Although they are most often lesions of the annexes, corneal and chorioretinal involvement can be detrimental for the vision.